Khaled M. Abdullah, MD

Grateful for the opportunity from @atiya_dhala to give a talk today on #PEEPtitration in #ARDS at the #ISAC2026 @Methodistpccm Here are the major take-home points: We’ve been taught to fear #PEEP because of the RV. But the real problem isn’t PEEP. It’s the wrong PEEP. 🧵👇

@NephroP @jainPOCUSology @IM_Crit_ For IJ CVCs, they end up at the cavo-atrial junction. But when I do subclavians, I’ve had times where the catheter ended up going to the IJs or the other subclavian vein instead. This allows me to have full confidence that the wire and catheter will 100% be in the right spot.

Unfortunately I ended up placing more midlines than CVCs during training, so just trying to understand this better, why does guidewire position matter, assuming you’re not advancing a longer catheter than intended for the insertion site, and the tip is going to end up at the SVC–RA junction (or just a bit deeper) anyway?

#POCUS pearl: confirm your wire during CVC placement by checking the IVC. Especially useful for subclavian insertions when you don't get PVCs or you're worried the wire took a detour. #FOAMed #PulmCrit

@NephroP @jainPOCUSology @IM_Crit_ Guess you could do it for both, but I was implying triple lumen CVCs. With swans though, the introducer would be short enough so that I wouldn’t necessarily need to see where the wire ends up.

@Khalemedic @jainPOCUSology @IM_Crit_ Talking about triple lumen or pulmonary artery catheter 🤔

I wrote this in a moment I never would have chosen. A sudden pause that made me see my life clearly. The meaning of our work is profound. This experience simply helped me see more clearly what matters most. “Time is Finite” JAMA jamanetwork.com/journals/jama/…

@SaudiRTs @ArielG_RRT @IM_Crit_ @Thind888 @DeepaGotur @VincentWang_DO @Md1Faisal @ThinkingCC @jainPOCUSology @ross_prager @cardiojaydoc02 @Methodistpccm @MoeBitar @AvrahamCooperMD

Bottom line: ✅ We don’t cause RV failure by using PEEP. ✅ We cause it by using the wrong PEEP. #MedTwitter #CriticalCare #FOAMed

Grateful for the opportunity from @atiya_dhala to give a talk today on #PEEPtitration in #ARDS at the #ISAC2026 @Methodistpccm Here are the major take-home points: We’ve been taught to fear #PEEP because of the RV. But the real problem isn’t PEEP. It’s the wrong PEEP. 🧵👇

Inhaled treprostinil in #IPF (TETON-2): ↓ Decline in FVC ↓ Risk of clinical worsening Interesting results for a disease where options remain limited. #MedTwitter

@ThinkingCC @Methodistpccm @DeepaGotur I agree. It’s been messy to apply blanket statements to a heterogenous population. I wish some things were different (like no more 30 cc/kg lol), but at least there was mention of clinical evaluation, comorbidities, and healthcare system factors. Can it be better? Yes, I agree.

@Khalemedic @Methodistpccm @DeepaGotur Umm…these guidelines are pretty much one size fits all IMO…

Sepsis is evolving! We’ve moved past the “one-size-fits-all” approach. Not every patient needs 30 cc/kg. Not every patient is fluid responsive. And even if they are fluid responsive, early pressors should still be considered instead of reflexively ordering more fluids.